Anesthesia Flashcards
Which anesthetic is not affected by renal disease?
Rocuronium
What kinds of effects does roc/vec have on the CV system?
Nothing significant
If anything, what can prolong the action of roc/vec?
Liver disease
Which non-depolarizing neuromuscular blocking drug can cause bronchospasm?
Atracurium
Explain why Neostigmine and Glycopyrrolate should be given together
If glyco is not given, Neo can cause bradycardia, bronchospasm, secretions, intestinal spasms and pupil constriction
About how long does it take for Neostigmine and glycopyrrolate to reverse the NM blockade?
~4-10 min
What part(s) of the body do the supraclavicular and infraclavicular blocks block?
Arm/Elbow/Hand
What do you have to think about when a patient gets a block in the upper half of the body?
Pneumothorax
Which artery do you have to be cautious of with the Supracalvicular and infraclavicular nerve blocks?
Subclavian A.
Which nerve may be spared when blocking the supraclaviular and/or infraclaviular nerves?
Ulnar N.
Which nerve can possibly cause ipsilateral phrenic nerve paralysis?
Supraclavicular N. Block ~50%
Interscalene N. block
Which area does the PECs blockade block?
Intercostal nerves
Which artery is in proximity to the PECs nerve block?
Thoracoacromial a.
What type of surgery uses an interscalene block?
ONLY shoulder
What are some side effects of an interscalene nerve block?
recurrent laryngeal paralysis (aka hoarseness)
What are signs of Horner syndrome?
drooping eyelid, blurred vision, decreased pupil size
What are reasons to not give a nerve block?
local infection, serious coagulopathy, allergy or refusal
What does giving nitrous oxide put you at high risk for?
PONV
What are some reason to not give nitrous oxide?
air embolism, pneumo, bowel obstruction, intra-ocular bubbles, tympanic grafting (anything where added air would make the situation worse)
Which inhaled anesthetic is not likely to cause a bronchospasm?
Sevoflurane
Why shouldnt desflurane be given as an induction anesthetic?
Due to strong odor it could cause bronchospasm and coughing
What are some reasons to not give sevoflurane or desflurane?
severe hypovolemia, susceptibility to MH, intracranial HTN
How is versed metabolized?
Metabolized in liver, excreted in urine
What are possible side effects of Versed?
Can worsen psychosis, agitation and dementia in elderly
What is a down fall from using Versed?
No analgesic properties
What is a benefit of using Nitrous oxide?
Has analgesic properties
When is the best time to use Ketamine?
In hypvolemia, shock and trauma
asthmatics - bronchodilator
What are some side effects of Ketamine and possible solutions?
Hallucinations, give with benzos to help
Salivation, give glyco
Which patients should be monitored carefully when given Ketamine?
CAD, uncontrolled HTN, CHF
What is a benefit of propofol?
Can be used in ESRD and heptatic failure
What are some “issues” of propofol?
Burning sensation upon insertion, no analgesic effect
What can prolong the action of succinylcholine? What actions might need to be taken?
hypothermia and pseudocholinesterase. If pt has the deficiency, might need to be put on mechanical ventilation and sedated until the medicine wears off.
What is a MAJOR side effect of succinylcholine?
HYPERKALEMIA, MH, laryngospasm, myalgias, masseter rigidity
What meds should not be given with succynincholine?
neostigmine, MAOIs, esmolol, reglan
Which population shouldn’t be given succinylcholine
Pediatrics UNLESS for emergent intubation d/t possiblity of undiagnosed cardiac issues and high probability of laryngospasm
What type of surgeries use an adductor canal block?
Knee and leg
Which part of the leg does the adductor block not cover?
posterior or sometimes lateral knee
Which artery is close to the adductor canal block?
Femoral Artery
Which nerve(s) is/are blocked by the adductor canal block?
saphenous n.
What type of surgery uses a popliteal sciatic nerve block?
Foot and ankle
What is a benefit of using a popliteal sciatic nerve block?
Spares the hamstrings making it easier to walk
Which vessels do you have to be cautious of around a popliteal sciatic nerve block?
popliteal vessels
Which med/mixture and dosage is used for malignant hyperthermia?
Dantrolene in Sterile water, 2.5mg/kg IV
What are other treatments to help with malignant hyperthermia?
charcoal filters, 100% O2, cooling measures (cold towels) until core is 100.4
Call hot-line
Which medications trigger malignant hyperthermia?
inhaled agents (sevoflurane, desflurane, isoflurane), succinylcholine, halothane
What are some early signs of maligant hyperthermia?
Unanticipated doubling/tripling end tidal CO2, unexpected tachycardia, tachynpea, and JAW RIGIDITY
What are some major things to monitor for with a patient that has malignant hyperthermia?
DIC, metabolic acidosis
What are signs for DIC?
extreme bleeding,
Hypothermia, acidosis, coagulopathy
What causes L.A.S.T.
large doses of local anesthetic from local cases or nerve blocks
What are early signs of LAST
dizzy, lightheaded, metallic taste, slurred speech,
What are late signs of LAST?
hypotension, bradycardia, Vtach
How is LAST treated?
Lipids, O2, benzos, barbiturates
What causes a postdural puncture HA?
Lumbar puncture, more commonly after an epidural
What is the reversal of inhaled anesthetics?
The action of inhaled anesthetics is so quick, it just needs to be turned off
What affect does Versed have on anesthesia?
Prolongs sedation
Which patients should not receive succinylcholine?
pts w/ extensive burns, severe trauma, severe abd infections, NM disease, paraplegia/quad
With what type of patient should you be careful when giving neostigmine?
Cardiac, can cause dysrhythmias
